Faculty Bibliography

Despite significant advances in our understanding or renal tubular cell function, the in vivo handling of E. coli by renal tubules has not been previously investigated. The present studies were, therefore, designed to study this aspect of nephron function. Live and dead E. coli and vehicle alone were microinjected into the proximal tubular lumen of a single nephron of rats, and the microinjected tubules were morphologically studied at one-half, two, four, and six hours after. The bacteria initially contacted the luminal cell membrane. The luminal cell membrane adjacent to the bacteria subsequently invaginated, and both live and dead E. coli eventually became internalized into the tubular epithelial cytoplasm. Since dead E. coli are unlikely to invade the cells, their intracytoplasmic localization is a result of tubular epithelial phagocytosis. Similar microinjections of dead E. coli together with rat erythrocytes revealed a preferential phagocytosis of dead E. coli. Examination of the microinjected nephron with dead E. coli 48 hours after also demonstrated a development of microscopic interstitial nephritis surrounding the microinjected tubule. In conclusion, the renal tubular epithelia of the proximal and distal segments of rat nephron have phagocytic potential for E. coli which are further capable of inducing an inflammatory reaction around the microinjected tubule.

This paper describes a technique for identifying individual nephrons that have been subjected to micropuncture. The general location of the nephron is marked on the surface of the kidney by implanting two micropipette tips on opposite sides of it two or three tubule diameters away. The tubule itself is marked by the injection into the lumen of a tracer material, for purposes of this account, a suspension of E. coli. After perfusion fixation the kidneys are removed and a block of tissue containing the extrapapillary portion of the nephron is excised. This block is cut into thin slices parallel to the surface of the kidney; these are embedded in plastic for subsequent sectioning. On sectioning, the marker material makes the nephron in question readily discernible under the microscope. A major advantage of this technique is that it allows the tubule of interest to be located as much as 48 hours later.

Hypertension of unknown cause is generally termed "essential." Because hypertension has long been considered a possible complication of lead poisoning and the EDTA lead-mobilization test has proved to be a sensitive indicator of excessive body stores of lead, we used this test to evaluate cumulative past lead absorption in 48 men diagnosed as having essential hypertension. Patients who had hypertension with reduced renal function (i.e., serum creatinine level greater than 1.5 mg per deciliter [133 mumols per liter]) had significantly larger amounts of mobilizable lead than did patients who had hypertension without renal impairment. The increase in mobilizable lead was not due to the renal disease itself, since 22 control patients without a history of essential hypertension but with comparable renal impairment from known causes excreted significantly less lead chelate during the three-day test. These data suggest that lead may have an etiologic role in the renal disease of some patients usually designated as having "essential" hypertension.